This is one of the federally-funded, anti smoking ads created by the Centers for Disease Control and Prevention that aired in spring 2012 online, in print and on TV. / HO AFP/Getty Images

by Wendy Koch, USA TODAY

by Wendy Koch, USA TODAY

Want a smoker to quit? Scare, shock or disgust him. That's what the U.S. government did with its first federally funded anti-smoking ad campaign and, new data suggest, it worked.

An estimated 1.6 million Americans tried to quit and at least 100,000 likely succeeded as a result of graphic ads that showed how real ex-smokers had suffered paralysis, stroke, lung removal, heart attacks and limb amputations, according to a study Monday by the Centers for Disease Control and Prevention. The first round of ads ran from March through May in 2012, followed by a second one this past spring. A third round is planned for next year.

The CDC created the startling ads after consulting with smokers, who urged it to make the statistics about smoking - that it's the leading cause of preventable death and that it shortens life expectancy by 10 years - real. So it focused on the effects of smoking-related disease rather than the risk of death.

"I wish we could make upbeat, happy ads," but that's not what smokers said would motivate them to quit, says Tim McAfee, director of CDC's Office on Smoking and Health. He says the U.S. government doesn't have the luxury of financing "positive" imagery if it doesn't work.

The CDC study, published in The Lancet, surveyed a randomly selected, nationally representative group of 3,051 smokers and 2,220 non-smokers before and after the first ad campaign. About three-quarters recalled seeing at least one of the Tips from Former Smokers ads on TV, and smokers reported 12% more attempts to quit after the campaign than before it.

Since research suggests only about 6% of quit attempts succeed long-term, the study estimates that at least 100,000 of those who tried will probably succeed. It also found that during the campaign, its national toll-free quit line (1-800-QUIT-NOW) got 132% more calls and its website (www.smokefree.gov) attracted 500,000 more visitors than usual.

What surprised Erika Sward, assistant vice president of national advocacy at the American Lung Association, was the response of non-smokers. The study found that 35.2% talked to friends or family about the dangers of smoking after the campaign compared to 31.9% who did so before it.

"Family support and encouragement is ... really paramount," she says, because "quitting smoking is extraordinarily hard to do."

McAfee says the 2012 ads cost $54 million, a fraction of what the tobacco industry spends each year on marketing. He says they paid off handsomely. The study estimates that the successful quit attempts added up to a half million "quality" life years to the U.S. population. The CDC says smoking adds $96 billion each year to the U.S. health care tab so quitting saves a lot of money.

CDC's campaign could serve as a model to low-income and middle-income countries that are facing tobacco epidemics such as China, India, Bangladesh, Egypt, Indonesia and Russia, according to a commentary by three Chinese researchers at the Beijing Chao-Yang Hospital that was published in the same issue of The Lancet.

"In developing countries such as China, doubts remain about the harms of tobacco," writes Dan Xiao and two colleagues, noting a study that found three-quarters of adults in China were not fully aware of its risks. They suggest China's government increase tobacco taxes and finance anti-smoking ads.

Which device is most likely to help smokers quit? A study published Saturday, also in The Lancet, found that electronic cigarettes work about as well as nicotine patches. After three months of using these cessation methods, a six-month followup found that 7.3% of e-cigarette users were still not smoking compared to 5.8% of patch users. The authors, led by Chris Bullen of the University of Auckland in New Zealand, said the difference was not statistically significant.